Giant Cell Tumor¶
Definition¶
Giant cell tumor (GCT) of bone is a locally aggressive, typically benign neoplasm that rarely involves the spine (3–7% of all GCTs). In the spine, GCT most commonly affects the sacrum and vertebral body, particularly in patients aged 20–40 years. It is characterized by multinucleated giant cells on histology and has a high local recurrence rate.
Imaging Findings¶
MRI¶
- Expansile lytic mass centered on the vertebral body, often extending into the posterior elements
- Low to intermediate T1, heterogeneous T2 signal
- Fluid-fluid levels may be present (secondary aneurysmal bone cyst component in up to 14%)
- Enhancement is heterogeneous
- In the sacrum, often eccentric (unlike chordoma which is midline)
CT¶
- Expansile lytic lesion with thinned or destroyed cortex
- No matrix mineralization (no calcification or osteoid)
- May have a thin sclerotic rim
- Soft tissue extension is common in large lesions
Clinical Pearl
In the sacrum, the two most common tumors are chordoma (midline) and giant cell tumor (eccentric). Both are lytic and destructive, but chordoma has very high T2 signal and a large midline presacral mass, while GCT is more eccentric, has heterogeneous T2 signal, and may contain fluid-fluid levels from a secondary aneurysmal bone cyst component.
Management¶
- En bloc resection when feasible (preferred for sacral GCT)
- Curettage with adjuvant therapy for vertebral body lesions
- Denosumab (RANKL inhibitor) has shown significant efficacy in reducing tumor size preoperatively
- Serial embolization for unresectable sacral lesions
- Recurrence rate is 30–50% after curettage
Key Points¶
- GCT is a locally aggressive benign tumor, most common in the sacrum when spinal
- Eccentric sacral location distinguishes it from midline chordoma
- Fluid-fluid levels suggest a secondary aneurysmal bone cyst component
- Denosumab is an effective medical treatment
- High recurrence rate after curettage
References¶
- Shi LS, Li YQ, Wu WJ, Zhang ZK, Gao F, Latif M. Imaging appearance of giant cell tumour of the spine above the sacrum. Br J Radiol. 2015;88(1051):20140566. doi:10.1259/bjr.20140566.
- Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk GR Jr. Giant cell tumor of bone: review, mimics, and new developments in treatment. RadioGraphics. 2013;33(1):197–211. doi:10.1148/rg.331125089.
- van Langevelde K, Cleven AHG, Navas Cañete A, van der Heijden L, van de Sande MAJ, Gelderblom H, Bovée JVMG. Malignant transformation of giant cell tumor of bone and the association with denosumab treatment: a radiology and pathology perspective. Sarcoma. 2022;2022:3425221. doi:10.1155/2022/3425221.
- Amary F, Berisha F, Ye H, Gupta M, Gutteridge A, Baumhoer D, et al. H3F3A (histone 3.3) G34W immunohistochemistry: a reliable marker defining benign and malignant giant cell tumor of bone. Am J Surg Pathol. 2017;41(8):1059–1068. doi:10.1097/PAS.0000000000000859.
- Leinauer B, Wolf E, Werner M, Baumhoer D, Breining T, Luebke AM, et al. H3F3A-mutated giant cell tumour of bone without giant cells—clinical presentation, radiology and histology of three cases. Histopathology. 2021;79(5):720–730. doi:10.1111/his.14401.
- Hosseinzadeh S, Tiwari V, De Jesus O. Giant cell tumor of bone. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559229/.
- Gaillard F, et al. Giant cell tumour of bone. Radiopaedia.org. Available from: https://radiopaedia.org/articles/giant-cell-tumour-of-bone.